Provider Demographics
NPI:1881634517
Name:GREENE COUNTY GENERAL HOSPITAL
Entity Type:Organization
Organization Name:GREENE COUNTY GENERAL HOSPITAL
Other - Org Name:FREELANDVILLE COMMUNITY HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:REETZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-847-2281
Mailing Address - Street 1:310 W. CARLISLE ST.
Mailing Address - Street 2:
Mailing Address - City:FREELANDVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47535-0288
Mailing Address - Country:US
Mailing Address - Phone:812-328-2314
Mailing Address - Fax:812-238-2212
Practice Address - Street 1:310 W. CARLISLE ST.
Practice Address - Street 2:
Practice Address - City:FREELANDVILLE
Practice Address - State:IN
Practice Address - Zip Code:47535-0288
Practice Address - Country:US
Practice Address - Phone:812-328-2314
Practice Address - Fax:812-238-2212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05-000355-1314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100273640AMedicaid
IN155688Medicare Oscar/Certification